The number of Alaskans covered by Medicaid has dropped by more than 14,000 since April, after federal protections in response to the COVID-19 pandemic ended. This number may increase as the state continues the process of determining who is still eligible, which was halted during the national emergency declaration.
Those Alaskans are losing coverage as the state’s Health Department continues work to clear a backlog of new Medicaid applicants that has piled up in its Division of Public Assistance since last year.
The federal government recently told the Department of Health that it is concerned about that rate and how state delays processing new applications may impede equitable access to care and exceed limits for how long it should take to determine whether people applying for Medicaid are eligible. Medicaid is the primary health coverage for low-income Americans. State officials say they’re making progress, but another issue – a backlog in food stamp applications – has been a priority.
In a letter, the federal Centers for Medicare and Medicaid Services told the Department of Health it is not meeting federal requirements for processing new Medicaid applications on time and is underperforming in the process of determining whether people can stay in the program.
The Centers for Medicare and Medicaid Services sent letters to all states that assessed their performance on three measurements — call center performance, paperwork issues and slow processing times. Most are behind on at least one. Only Alaska, Florida, Montana, New Mexico and Rhode Island are behind on all of them.
The periodic checks on whether people remain Medicaid-eligible, known as “redeterminations” or “renewals” were halted by the federal government at the beginning of the pandemic and restarted in May. Eligibility depends on income and other factors, such as pregnancy.
The state has processed nearly 19,000 of the roughly 260,000 redeterminations it must make in the next year and a half. Of the redertmination the state has reported, nearly 30% of Alaskans lost coverage because of problems with their paperwork. The federal government said the high rate indicates that people aren’t getting notices to renew, that they cannot understand them or that they cannot submit their new forms.
It has completed a small part of a large task and already many Alaskans have lost coverage. Medicaid enrollment in Alaska dropped by 14,398, from 264,649 on April 30 to 250,251 by the end of July, according to state statistics.
It is likely to be a result of the redeterminations, said Deb Etheridge, who became the director of the Division of Public Assistance early this year after reports of a catastrophic backlog in food stamp benefits. She said it may also be in part because Alaskans have come off the rolls as the state works through its backlog.
The state began the renewal process in spring. In May and June, it took on 4,000 renewals each month. In each of those months, roughly 3,000 Alaskans came off the Medicaid rolls as a result, whether because they were found ineligible or had not completed their paperwork. The state increased the number of renewals to 11,000 in July and has not yet reported the number of people who have lost coverage.
“It did look like we had more procedural closures than the previous two months,” Etheridge said, referring to cases where people lost coverage because the state did not receive the right paperwork.
Etheridge is working with a data consultant to better understand the reasons behind the paperwork issues.
Backlog slowdowns
The federal concerns come as the Division of Public Assistance also works to clear a backlog of new Medicaid applications. In addition, the division has been working on yet another application backlog – for food stamps, which affected roughly 19,000 Alaskans. State workers say the backlogs are a result of chronic understaffing and deep workforce cuts as well as outdated computer systems. As a result of the efforts to dig out from under the backlogs, the state is late processing 40% of new Medicaid applications.
Etheridge said the federal government’s warning letter doesn’t quite capture what’s going on in Alaska with the Medicaid renewals process, because the system in the state is still recovering from dysfunction. Post-pandemic Medicaid renewals are being processed on time, though, Etheridge said. The delays are only affecting new Medicaid applications, she said.
“Until we’re sort of cleared of that backlog, they’re always going to be factored into our timeliness” handling new applications, she said.
Etheridge said she doesn’t know how many people are stuck in the backlog because of computer system dysfunction, which she hopes to have solved by the end of the month.
Etheridge said the state has already made progress on the food stamp backlog, with only 3,000 applications left to determine their eligibility. Etheridge aims to have those processed by October.
State solutions
The Department of Health got permission from the federal government to hold off on rural renewals to decrease the number of people who lose coverage, Etheridge said. The division is processing urban Medicaid renewals first, because rural residents tend to be subsistence hunting, fishing and gathering in the summer months.
“We recognize that in rural Alaska, people aren’t necessarily around in July,” she said.
It is important for people to be home, answering the phone and checking their mail because it increases the chances that they will see the state’s notice and send in their renewal paperwork on time.
Alaska has more time than other states to finish processing renewals. Most states have 12 months to process Medicaid renewals and remove people who no longer qualify for coverage. However, Alaska’s high rural population contributed to a federal extension that gives the state 18 months to review the roughly quarter million residents who are enrolled in Medicaid.
Despite the concerns raised by the federal government, Etheridge said the division is going out of its way to make sure dropping people for procedural reasons happens as little as possible.
“This is a new way of doing business,” she said. “We are calling people if we don’t receive their packets back. We’re doing some outreach to try to reach people before we actually do those closures. So it’s a second level that the Division of Public Assistance hasn’t really necessarily done in the past.”
She said people usually have 90 days to get late paperwork to the state after they lose coverage, but while these renewals are happening the state has doubled that deadline to 180 days.
Additionally, Etheridge said the department is hiring more full-time staff to manage Medicaid renewals. She said she is waiting for the state to post 15 new job openings.
The Legislature funded those positions with a fast-track budget bill proposed by Gov. Mike Dunleavy in March. It garnered support as a solution to the food stamp backlog.
Alaskans who find that after three years of pandemic protections they no longer qualify for Medicaid still have a right to an appeal, called a fair hearing.
If the division must end the benefit, Etheridge said it automatically transfers that person’s information to the federal marketplace where they can find health insurance. “First and foremost, most important is that people have access to health care in Alaska, and Alaskans have information about health care eligibility,” she said.
Medicaid information can be updated with the state online.
• Claire Stremple is a reporter based in Juneau who got her start in public radio at KHNS in Haines, and then on the health and environment beat at KTOO in Juneau. This article originally appeared online at alaskabeacon.com. Alaska Beacon, an affiliate of States Newsroom, is an independent, nonpartisan news organization focused on connecting Alaskans to their state government.
